HomeMy WebLinkAboutPermit Miscellaneous 1990-11-14
IIN'PECTION LINE
726-3769
...
Job Address '?39? (\{) 0
Legal Description I' )()~{.jO (j)
CITY UF SPRINGFIELD
COMBINATION APPLlCATION/PERMlT
OwnerLu )~\~
Address 'fJ( ') \~"l u ") \~ Phone
Ce'J.~ C\l~
Construction Lend~\ r;0~ \. -\ ~"'14
Address - ~C\\\ \ l '\ \ ~6(}Phone
Ut>loN I tAl.!
(name)
(address)
INFORltATIDN UNt
726-3753
Sq. Ftq. I.\ain
~q. Ftg. Access. ~
Sq. Ftq, Other \
Ilew Add A Her Pep.
--Fence Demo Change/Use
ValuE oq't(y}O -Other- - rp
Bullciino Pe"nit Info: Describe Work(Le.. Build Single ~
Familv Residence Wit~.ttaChp.d r,!r!op'\ II~
,~t'~Dr1l~\(\N ~(\ I~
\.A lYt~ V SID\(\ t ~ ~\\ n\\\\I~() I
- (lies. no.) (exo;res) (ohone no.)
_.
EIIERr,y SOURCES:
Heat
(-later Heater
Range
Primary
Structura 1
Electrical
Mechanical ~
CONTRACTOR~l (namel
Genera 1 l
U\lf\ ~
Electrical 11\.!rr.,
~1echanical V\ n )
I
PLUltBI NG
(addr~ss)
f1 ir:<;.. no.)
(exni rps)
(l)hnnp nn., \
Plumbinq
ELECTRICAL
CCL ..cHARliE.' Nn
MECHANICAL
NO,
FFF
rHARr,F
Nn
Each single fixture
Residence of
~n rl-l~
SQ. FT.
furnace/burner to
BTUls
Relocated building
(new fix, additional)
New circuits alts.
or "extensions
Floor furnace
and vent
S.F. Residence
11 bath 1
Duplex (1 bath) each
Additional bath
SERVICES
Recessed wall
~n~rp hp~tpr ~nrl vpnt
Storm Sewer
Of
amps.
Appliance vent
~eD.,ratp
Stationary evap.
cooler
Vent fan with
sinale duct
Vent system apart from
heatina or A.C.
Mechanical exhaust
hood ~nd dud.
Sewer
Temporary Construction
Change in existing
rps j rlJ>J1rp
multifamily, camm. or
Industrial
Water service
COMM./IND. FEEDERS
Install/alter/relocate
di~trih. fppdpr~
Wood stove/heater
Of
amps.
TOTAL CHARGES
WHERE STATE L~W REQUIRES
shall not be vali1 until the
I SSUANCF OF PFR'lIT
TOTAL CHARGES TOTAL CHARGES
that the Electrical work be done by an Electrical Contractor, the electrical portion of this permit
label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFULLY EXAMINED the completed application for permit, and do hereby certify that all information hereon is true
and correct, and I further certify that any and all work oerformed shall be done in accordance with the Ordinances of the City
of Springfield and the Laws of the State of Oregon pertaining to the work described herein, and that" 1m OCCUPAr~CY will be made
of any structure without the permission of the Building Division. I further certify that my registration with the Builder's
Board is in full force and effect as required by ORS 701.055, that if exempt the basis for exemption is noted hereon, and that
only subco~tractors and employees who are in compliance with OP.S 701.055 will be used on this project.
WAlIE(please p,\../ RQ/l Ntt./J I ll/ k&J1v SIGNATURE ~k I.ij,L
_ . A- FO~ OFFICE USE DIlL
VII)
Dm II IN /~fJ
I
Zone
Fire Zone
Type/Canst.
Bedrooms
Units
Occy Load
Occy Group
Sq. Ftg. t1ain x Value
Sq. Ftg. Access x Value
Sq. Ftq. Other x Value
~t'A \\ - ~-C\O I g'1QsrOTAL VALUATION
, CJ a,.' ~ Systems Development
-"', \ , \ Charqe (1.5%) .
Flood Plain
Stories
BUILDING PERI,I!T
Charges an~
Surcharges
-,u ~ Plan Ck, ConmlInd
__#_~tiL2?;!.__ 65'UBldo Ppr ~~e
-::z -= Plan Ck, Res
7.?"'" 30%/B1 do Per Fee
Fence
PLW1B ING PERMIT
Charges and
Surcharges
Demo
ELECTRICAL PERIIlT
Cha rges and
Sur,charges
'Sidewalk
f!ECHANICAL PERMIT
Charges and
Surcharges
AIC Pavi ng
I Curb Cut
I
Tot~.1 Cqmb. Permi t ,
TOTAL
I
78.~~
-
,
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish.
A. Job Address
B. legal Description
1. example- Tax Lot 100, Lane County Map Reference
17 oj 43
2. exa~le- Lot I. Block 3, 2nd Addition to
sprlngtield Estates
C. Name. etc. of owner and construction lender
O. Energy Sources .
'1. example- heat/electrical ceilin...Q/or forced air qas
2. examole- waterheater/electrical/or solar
E. Square footage or'valuation, etc. -
I. example- 1250 sq. foot house, 500 sq. foot garage
2. example- if n~w project, check-new - if addition,
check add, etc.
F. Building pennit infonnation:
1. exam~le - construct single family house with an
attached garage
2. example - remodel existing garage into family room
3. examole - convert single family residence into
restaurant (change of use)
G. Value of work as defined in Section 303 (a) of the
Structural Specialty Code
H. DESIGN TEAM AND CONTRACTORS
To avoid design or construction delays. Building
Division Staff must be able to contact appropriate
persons regarding1design information or jab site
corrections. etc.
II. Abbreviated Plumbing, Mechanical. & Electrical Schedules
A. Except where blank spaces occur in the description
portion of the Mechanical and Electrical Schedules,
the applicant need fill-in only the No. Boxes adjacent
to the appropriate item(s) to be installed
8. Full Plumbing, Mechanical, and Electrical Schedules
are available at the Building Division
1. To conserve space on the permit form the schedules
have been abbreviated
2. If the item(s) to be installed are not covered on
the abbreviated schedules you should consult the
full schedules
C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULES
D. As noted on the CAP, the label must be delivered to the
electrical contractor for signature by his electrical
supervisor. The general contractor is .not authorized
to sign the electrical label. ---
III, Applicant to sign and date
Whenever possible, the initial application will be used as
a worksheet only. Where possible. Building Division Staff
will prepare a type written copy and return it to the
applicant at the time'the actual permit is issued for his
signature. I
IV, Fees and Charges ,
Plan check fees are due and payable at the time of the
application. and no plans will be processed until these
fees are paid. All other fees and charges are due and
payable when the perm~t is issued.
V. FOR OFFICE USE ONLY
PROJECT CONDITIONS 'TO BE SATISFIED BEFORE OCCUPANCY:
.
- "
. '
PERMIT VALIDATION
i:b ( 873(0'
Permi t
clerE;1L[X)')
I
Permit applicant exempt from registration with the Builder's Board because:
Additional Project:Information:
PLANS REVIEWED BY:
,
) -.. .... .
.
name
~R.;yt:!: ffu:-:- ..=:1'"
/7 ";>-..."-?, /
Signature~~~~date !/-/~9~
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